Another scathing report causes more eminent heads to roll in the Macchiarini scandal

The scandal surrounding Paolo Macchiarini, the former star surgeon who became famous for his pioneering trachea transplants, has prompted yet another round of resignations and firings at the highest levels of Swedish higher education. On Monday evening, Swedish Minister for Higher Education and Research Helene Hellmark Knutsson said she had dismissed the country’s chancellor in charge of all public universities, Harriet Wallberg-Henriksson, following the release of a sharply critical report by an independent commission that examined the Karolinska Institute’s (KI’s) hiring and management of Macchiarini. Wallberg-Henriksson was vice-chancellor of KI in Stockholm, a position comparable to that of a university president, when Macchiarini was hired, and played a key role in his recruitment.

The minister also announced that all remaining KI board members who were active during Macchiarini’s tenure would be replaced. Five had already stepped down, including chairman Lars Leijonborg, who resigned Friday after receiving the panel’s report.

The affair continues to threaten the credibility of the world's most prestigious scientific award as well. Today, the Nobel Assembly—which chooses the winner of the prize for physiology or medicine—asked Wallberg-Henriksson and another former KI vice-chancellor, Anders Hamsten, to resign their membership of the assembly. Both had already said they would not take part in this year’s prize deliberations, as had three other members involved in the affair. (Urban Lendahl stepped down as secretary general of the assembly in February.)

Removing Hamsten and Wallberg-Henriksson is a step in the right direction, says Bo Risberg, a professor emeritus of surgery at the University of Gothenburg in Sweden, who in January called for the prize to be suspended for a year because of the scandal, and the award money donated to Macchiarini’s patients and their families. That would allow for a fresh start, he says. “The Nobel Prize and the Karolinska are intimately related, particularly to observers outside Sweden,” he says. The Macchiarini affair “is the biggest scandal we have ever had in Swedish medicine. … It affects the prize, too.”

Macchiarini made headlines when he implanted artificial tracheae that were seeded with stem cells into patients. Three of the operations took place at the Karolinska University Hospital, which hired Macchiarini, together with KI, in 2010. Two of the patients died and one has been in intensive care since the implant surgery in 2012.

“There was a stunning lack of interest in learning more about [Macchiarini's] work before extending his contract.”

The case has triggered a series of investigations and reviews. Just last week, an independent panel that looked into Karolinska University Hospital’s role in the scandal issued its highly critical report. The new investigation delved into KI's recruitment and management of Macchiarini. The panel, headed by former president of Sweden’s Supreme Administrative Court Sten Heckscher, found serious flaws in the decision to hire the surgeon in 2010 and in its oversight of his work. It criticized the university “for its nonchalant attitude towards regulations,” and an “irresponsible attitude” regarding formalities in place to prevent mistakes. It sharply criticizes Wallberg-Henriksson for her role in recruiting Macchiarini. Her influence on the process and her personal contact with the surgeon “created some confusion about who had responsibility” for the hire, the panel wrote in an English summary of its report.

That confusion led the university to ignore red flags, the panel says. “KI received remarkably negative references, including information that Macchiarini had been blocked from a professorship in Italy, that there were doubts surrounding his research, and that his CV contained falsehoods,” the panel writes. “The content of these references was not passed on to either the file or to the Recruitment Committee.”

Wallberg-Henriksson also took an active role in the decision to extend Macchiarini’s contract in 2013, the panel found. Because the vice-chancellor had openly stated that she wanted to make Macchiarini’s visiting professorship permanent, the university did not formally evaluate his work before extending the contract. “For the 2013 extension there were countless circumstances that should have warranted such an evaluation,” the panel writes, including legal charges against Macchiarini in Italy in late 2012 and “objections to Macchiarini’s activities raised by the Karolinska University Hospital in 2013 that made the hospital decide to stop further transplantations and terminate its part of Macchiarini’s contract.”

However, the panel found, the university simply asked Macchiarini to describe his own work, translated his report, and submitted it to the recruitment committee. “We find this way of handling the matter inappropriate,” the panel writes. In a press conference yesterday, Heckscher went further. “There was a stunning lack of interest in learning more about his work before extending his contract,” he said.

The report also describes flaws in departmental record keeping, oversight of Macchiarini’s extracurricular work in Russia, and the way the misconduct investigations were handled. It says that vice-chancellor Hamsten’s decision to dismiss Gerdin’s conclusions was “poorly justified.”

The panel concluded that “a growing fixation on excellence” at the university and “the aspiration to close the gap between research and its application in healthcare” both played a role in KI's hands-off treatment of Macchiarini.

Gerdin says the decision to replace the board en masse was appropriate. “The board is responsible as a unit, not for what Macchiarini was doing in his lab, but for making sure the university has routines to ensure high scientific standards,” he says; loose oversight allowed Macchiarini to ignore those standards. The university has “slow, serious work” to do to rebuild its reputation, Gerdin adds. “But if something good comes out of it—better routines, better safety—the net outcome after this drama will be a better Karolinska. That is what we hope.”

Several other investigations into the affair remain open. Sweden’s Central Ethical Review Board is re-examining the original misconduct charges against Macchiarini; they are expected to release the first of several reports from that effort in the coming week. Macchiarini also faces several criminal inquiries. Swedish television reported that Macchiarini again denied any wrongdoing and said the charges against him were motivated by “pure malice.”